It is well established that there is a strong correlation between high blood lipid levels and CHD, in particular those with elevated Low Density Lipoproteins (LDL). As a result dyslipidaemia or hyperlipidaemia is a risk factor for CHD. As such a complete medical and lifestyle history should be obtained in order to determine CHD risk factors (see Table 1). [1]
Positive risk factors
Criteria
Family history
Myocardial infarction, coronary revascularisation, or sudden death before 55 years of age in
father or other first degree male relative or before 65 years of age in mother or other first
degree female relative.
Cigarette smoking
Current cigarette smoking, or smoking cessation within previous 6 months.
Hypertension
Systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg measured on two separated occasions, or
individual is taking anti-hypertensive medication.
Dyslipidaemia
TC ≥ 200mg/dl, or HDL-C < 40mg/dl, or LDL-C ≥ 130mg/dl, or on lipid lowering medication.
Impaired fasting glucose
Fasting blood glucose ≥ 110mg/dl, measured on two separate occasions.
Obesity
Body mass index ≥ 30kg/m2 or waist circumference >102 cm for men and >88 cm for women.
Physical inactivity
Not participating in regular exercise program or not meeting the minimum physical activity
recommendations from the ACSM and AHA (150min/week or more of moderate intensity
From the results of the CHD risk factor table (Table 1) individuals should be classified into one of three groups; low, moderate or high risk.
Low CHD risk: Individuals who are asymptomatic with no more than one risk factor.
Moderate CHD risk: Individuals who have two or more risk factors.
High CHD risk: Individuals who are symptomatic or have known cardiovascular, pulmonary or metabolic disease.
For those patients diagnosed with hyperlipidaemia or dyslipidaemia categorised in the low risk group, medical supervision is not required for exercise testing at moderate to vigorous intensities. Those categorised in the moderate risk group, medical supervision is recommended exercise testing at vigorous intensities (VO2max >60%). Those categorised in the high risk group, medical supervision is recommended exercise testing at both moderate and vigorous intensities[3] .
Dyslipidaemia and hyperlipidaemia and the resultant atherosclerosis is not in itself a contraindication to exercise. However, many individuals diagnosed with dyslipidaemia and hyperlipidaemia present with other co-morbidities which may exclude individuals from participating in an exercise program[4] .Table 2. outlines the absolute and relative contraindications to exercise. As such a complete medical history should be obtained prior to any exercise testing in order to rule out any contraindications to exercise. If individuals present with any of the below mentioned contraindications medical clearance is recommended prior to exercise testing or starting an exercise program. Individuals with absolute contraindications should not participate in exercise testing and subsequent exercise programme unless prescribed by a medical physician[5] .
Absolute Contraindications
Relative Contraindications
Acute myocardial infarction (within 2 days) or
other acute cardiac event
Left main coronary stenosis
Unstable angina
Moderate stenotic valvular heart disease
Uncontrolled cardiac arrhythmias causing
symptoms of hemodynamic compromise
Severe arterial hypertension; resting diastolic blood
pressure >110mmHg or resting systolic blood pressure
>200mmHg or both
Uncontrolled symptomatic heart failure
Tachydysrhythmias or bradydysrhythmias
Symptomatic severe aortic stenosis
Hypertrophic cardiomyopathy and other forms of outflow
tract obstruction
Suspected or known dissecting aneurysm
High degree atrioventricular block
Acute myocarditis or pericarditis
Ventricular aneurysm
Acute pulmonary embolous or pulmonary
infarction
Chronic infectious disease e.g. hepatitis, AIDS
Acute systemic infection, accompanied by fever,
body aches or swollen lymph glands
Uncontrolled metabolic disease e.g. diabetes
Mental or physical impairment leading to inability to exercise
adequately
Known electrolyte abnormalities
Table 2. Absolute and relative contraindications to exercise testing[6]
Certain medications used for the treatment of dyslipidaemia and hyperlipidaemia may have a negative impact on exercise. In addition, the use of combination medications may have increased negative effects of exercise. When prescribing an exercise programme for a client with dyslipidaemia or hyperlipidaemia, it must be taken into consideration what medications an individual has been prescribed.
Statins: May cause myopathy, myalgia, muscle weakness or muscle cramps during exercise.
Fibrates: Muscle weakness or pain during exercise may be seen with a combination therapy of Fibrates and Statins.
Cholesterol absorption inhibitors: May cause fatigue. Combination therapy with Statins may cause muscle weakness or pain during exercise.[7]
Careful planning must therefore be taken in prescribing exercise to clients on the above mentioned medications. It may be necessary to incorporate increased rest periods or reduce intensities to accommodate the adverse side effects associated with the above mentioned medications.
Specific dyslipidaemia or hyperlipidaemia conditions
There are many different types of dyslipidaemia and hyperlipidaemia conditions that an individual may present with. Several of these conditions react differently to exercise. Of particular note, those diagnosed with a familial dyslipidaemia may not experience the same alterations in lipid profile following exercise compared to a healthy population. More specifically, those diagnosed with familial triglyceridaemia may not have the same levels of improvement in blood lipid profiles as healthy individual.
On the other hand, hyper-α-lipoproteinaemia is characterised by high concentration levels of HDL. This hyperlipidaemia is seen to be beneficial to health as high levels of HDL have been inversely correlated with atherosclerotic disease.[8]
^ Biggerstaff, K.D. & Wooten, J.S. 2008, "Hyperlipidemia and Dyslipidemia" in Clinical Exercise Physiology, eds. J.K. Ehrman, P.M. Gordon, P.S. Visich & S.J. Keteyian, 2nd edn, Human Kinetics, United States, pp. 247-264.
^ Heyward, V.H. 2009, Advanced Fitness Assessment and Exercise Prescription, 6th edn, Human Kinetics, United States.
^ Thompson, W.R., Gordon, N.F. & Pescatello, L.S. (eds) 2009, ACSM's Guidelines for Exercise Testing and Prescription, 8th edn, Lippincott Williams & Wilkins, United States.
^ Biggerstaff, K.D. & Wooten, J.S. 2008, "Hyperlipidemia and Dyslipidemia" in Clinical Exercise Physiology, eds. J.K. Ehrman, P.M. Gordon, P.S. Visich & S.J. Keteyian, 2nd edn, Human Kinetics, United States, pp. 247-264.
^ Heyward, V.H. 2009, Advanced Fitness Assessment and Exercise Prescription, 6th edn, Human Kinetics, United States.
^ Thompson, W.R., Gordon, N.F. & Pescatello, L.S. (eds) 2009, ACSM's Guidelines for Exercise Testing and Prescription, 8th edn, Lippincott Williams & Wilkins, United States.
^ Kostoff, D. 2008, "Pharmacotherapy" in Clinical Exercise Physiology, eds. J.K. Ehrman, P.M. Gordon, P.S. Visich & S.J. Keteyian, 2nd edn, Human Kinetics, United States, pp. 31-59.
^ Biggerstaff, K.D. & Wooten, J.S. 2008, "Hyperlipidemia and Dyslipidemia" in Clinical Exercise Physiology, eds. J.K. Ehrman, P.M. Gordon, P.S. Visich & S.J. Keteyian, 2nd edn, Human Kinetics, United States, pp. 247-264.
Medical and Clinical Considerations
When testing and prescribing an exercise programme for a client diagnosed with dyslipidaemia or hyperlipidaemia there are several medical and clinical considerations. Things to consider when testing and prescribing exercise are Coronary Heart Disease (CHD) risk factors, contraindications to exercise, the effects of pharmacological on exercise and specific dyslipidaemia or hyperlipidaemia condition.
CHD risk factors
It is well established that there is a strong correlation between high blood lipid levels and CHD, in particular those with elevated Low Density Lipoproteins (LDL). As a result dyslipidaemia or hyperlipidaemia is a risk factor for CHD. As such a complete medical and lifestyle history should be obtained in order to determine CHD risk factors (see Table 1). [1]
From the results of the CHD risk factor table (Table 1) individuals should be classified into one of three groups; low, moderate or high risk.
For those patients diagnosed with hyperlipidaemia or dyslipidaemia categorised in the low risk group, medical supervision is not required for exercise testing at moderate to vigorous intensities. Those categorised in the moderate risk group, medical supervision is recommended exercise testing at vigorous intensities (VO2max >60%). Those categorised in the high risk group, medical supervision is recommended exercise testing at both moderate and vigorous intensities[3] .
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Contraindications to exercise
Dyslipidaemia and hyperlipidaemia and the resultant atherosclerosis is not in itself a contraindication to exercise. However, many individuals diagnosed with dyslipidaemia and hyperlipidaemia present with other co-morbidities which may exclude individuals from participating in an exercise program[4] .Table 2. outlines the absolute and relative contraindications to exercise. As such a complete medical history should be obtained prior to any exercise testing in order to rule out any contraindications to exercise. If individuals present with any of the below mentioned contraindications medical clearance is recommended prior to exercise testing or starting an exercise program. Individuals with absolute contraindications should not participate in exercise testing and subsequent exercise programme unless prescribed by a medical physician[5] .
other acute cardiac event
symptoms of hemodynamic compromise
pressure >110mmHg or resting systolic blood pressure
>200mmHg or both
tract obstruction
infarction
body aches or swollen lymph glands
adequately
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Pharmacological Effects on Exercise
Certain medications used for the treatment of dyslipidaemia and hyperlipidaemia may have a negative impact on exercise. In addition, the use of combination medications may have increased negative effects of exercise. When prescribing an exercise programme for a client with dyslipidaemia or hyperlipidaemia, it must be taken into consideration what medications an individual has been prescribed.
- Statins: May cause myopathy, myalgia, muscle weakness or muscle cramps during exercise.
- Fibrates: Muscle weakness or pain during exercise may be seen with a combination therapy of Fibrates and Statins.
- Cholesterol absorption inhibitors: May cause fatigue. Combination therapy with Statins may cause muscle weakness or pain during exercise.[7]
Careful planning must therefore be taken in prescribing exercise to clients on the above mentioned medications. It may be necessary to incorporate increased rest periods or reduce intensities to accommodate the adverse side effects associated with the above mentioned medications.Top of page
Specific dyslipidaemia or hyperlipidaemia conditions
There are many different types of dyslipidaemia and hyperlipidaemia conditions that an individual may present with. Several of these conditions react differently to exercise. Of particular note, those diagnosed with a familial dyslipidaemia may not experience the same alterations in lipid profile following exercise compared to a healthy population. More specifically, those diagnosed with familial triglyceridaemia may not have the same levels of improvement in blood lipid profiles as healthy individual.
On the other hand, hyper-α-lipoproteinaemia is characterised by high concentration levels of HDL. This hyperlipidaemia is seen to be beneficial to health as high levels of HDL have been inversely correlated with atherosclerotic disease.[8]
Top of page
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